Quality of Life Among Patients With Locally Advanced Pancreatic Cancer: A Prospective Nationwide Multicenter Study

Abstract

Background: Health care providers of patients with cancer should discuss the impact of treatment, such as multiagent chemotherapy and surgery, on quality of life (QoL). However, in the era of shared decision-making, data on QoL in locally advanced pancreatic cancer (LAPC) remain scarce. Methods: We performed a prospective multicenter study involving patients with LAPC across 13 Dutch centers. These patients were included in both the LAPC registry and the Dutch Pancreatic Cancer Project (PACAP; ClinicalTrials.gov identifier: NCT03513705). The study evaluated QoL over time and assessed the impact of treatment. The primary outcome was global health status (GHS) based on the EORTC Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Secondary outcomes included functioning and symptom scores from the EORTC QLQ-C30 and the EORTC QLQ Pancreatic Cancer Module (QLQ-PAN26). Outcomes were measured at diagnosis and at 3-month intervals up to 12 months. Outcomes were compared over time and between groups, with both statistical and clinical significance (D $10 points) evaluated. Results: A total of 170 patients completed at least one QoL-questionnaire. Most patients (n5152; 89%) received tumor-directed treatment, including 116 (68%) who received chemotherapy (6 radiotherapy) alone and 36 (21%) who underwent chemotherapy (6 radiotherapy) followed by resection; 18 (11%) patients received best supportive care (BSC). At baseline, GHS was highest among patients who received chemotherapy 1 resection (mean [SD], 70 [16]) compared with those receiving chemotherapy alone (mean [SD], 64 [20]) and BSC (mean [SD], 48 [21]) (P 5.001). The overall mean [SD] GHS at baseline was 63 [20] and remained stable over time (P 5.27), including in patients receiving tumor-directed treatment (P 5.57). One-third of the QoL subscales (9/28) showed statistically and clinically significant changes over time. Improvements were observed in appetite loss, pancreatic pain, and hepatic symptoms, although patients reported increased diarrhea, flatulence, altered bowel habits, and financial difficulties. Over time, patients reported reduced fear of future health, but a decline in health care satisfaction. Conclusions: This multicenter study demonstrated that general QoL remained stable during the first year in patients with LAPC, 89% of whom received tumor-directed treatment. Certain symptoms worsened and deserve greater attention from health care providers. These findings can guide shared decision-making and improve symptom management.